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WHEN THE PATIENT ASKS Brief reviews for you and your patients
Pamela Moyers Scott, MPAS, PA-C, DEPARTMENT EDITOR
Should I take coenzyme Q10 with a statin?
Lanae Williams, MPAS, PA-C; John Bradford, MPAS, PA-C
s heart disease continues to be the leading cause of death
A in America, statins are increasingly popular in current med-
ical therapy. Statins, or 3-hydroxy-3-methylglutaryl coenzyme A
(HMG-CoA) reductase inhibitors, are most commonly used to
treat hyperlipidemia and as preventive therapy for coronary
artery disease and stroke. Additionally, statins may benefit
those with Alzheimer’s disease, cancer, renal disease, osteo-
porosis, multiple sclerosis, macular degeneration, glaucoma, or
rheumatoid arthritis.1
The most common side effects associated with statin use
include constipation, diarrhea, dizziness, headaches, rashes, and
upset stomach. Typically these resolve with time. More serious,
but less common, adverse events are liver problems and myopa-
thy, which can range from slight myalgias to severe rhabdomy-
olysis resulting in kidney failure and death.2 Preventing statin-
induced myopathy is one focus of coenzyme Q10 (CoQ10, or
ubiquinone) use. With statin prescriptions on the rise and a vast
amount of information available through the Internet, patients
are asking more questions about taking CoQ10 supplements.
The statin-coenzyme Q10 connection
CoQ10 is a fat-soluble compound vital for a number of processes
related to energy metabolism. It also acts as an antioxidant scav-
enger. The compound is present in virtually all cells, with the high-
est levels in the heart, brain, liver, and kidneys.3-5 Although small
amounts of the compound are available in certain foods such as
meats and seafood, most CoQ10 is manufactured in the cells.
In addition to inhibiting HMG-CoA reductase, statins are
believed to halt the production of mevalonate, a CoQ10 precur-
sor. In this way, statins may also decrease CoQ10 levels in the
body. Evidence suggests that low CoQ10 levels may cause mito-
chondrial dysfunction, which results in myopathy.6
Benefits are inconsistent
There is considerable evidence that patients who take statins
have lower levels of endogenous CoQ10.7 However, a 2001 ran-
domized crossover trial of 12 participants found no significant
decrease in CoQ10 levels after initiation of selected statins.8
Lanae Williams works in emergency medicine and family prac-
tice at Pondera Medical Center in Conrad, Mont. John Bradford
is a physician assistant in family practice with the National
Health Service in Edinburgh, Scotland. They have indicated no
relationships to disclose relating to the content of this article.
Pam Scott is the owner of Physician Assistant Medical Services
(P.A.M.S.) in Williamsburg, WVa, a past president of the AAPA,
and president of the Society for the Preservation of PA History.
Two other studies found that CoQ10 use reduced the effects of
myopathy in patients taking statins, but this research was for
an investigational cancer treatment using small numbers of
participants who were taking very high dosages of statins. It is
not known if the results would be the same for patients taking
typical dosages of statin drugs.9 CoQ10 supplements may be
effective for other conditions, such as heart failure and Parkin-
son’s disease; however, evidence supporting these indications
is inconsistent.
When taken as a supplement, CoQ10 appears to be well tol-
erated. Fewer than 1% of patients in clinical trials report GI dis-
tress. CoQ10 supplements could adversely interact with war-
farin. Additionally, CoQ10 may have hypotensive and hypogly-
cemic effects, so patients with low blood pressure or diabetes
should be monitored closely.4 CoQ10 does not affect the choles-
terol-lowering effects of statins. The most common dosages
are 50 to 200 mg daily in divided doses. Patients should not
take more than 300 mg per day because higher dosages have
been associated with elevated levels of liver enzymes.7
What patients must know
Patients should be counseled to contact their health care
provider if they develop severe muscle aches, weakness, fever,
or any other side effect while taking these drugs. Consider
assessing baseline creatine phosphokinase and liver enzymes
with any new statin prescription.
When patients ask about supplementing statins with CoQ10,
explain that available evidence does not support this practice.
However, when taken at the recommended doses, CoQ10 likely
poses little health risk. Patients should also be reminded of the
proven benefits of statins, as well as the importance of lifestyle
changes such as eating a low-fat diet and exercising regularly. ■
REFERENCES
1. Lesher BA. An update on potential new uses for statins. Pharmacist’s Letter/Prescriber’s
Letter. 2004; Detail-Document #200701.
2. Patient handout: What you should know about statins. Prescriber’s Letter. Available
at: http://www.prescribersletter.com. Accessed November 7, 2006.
3. Greenberg S, Frishman WH. Co-enzyme Q10: a new drug for cardiovascular dis-
ease. J Clin Pharmacol. 1990;30(7):596-608.
4. Bonakdar RA, Guarneri E. Coenzyme Q10. Am Fam Physician. 2005;72(6):1065-1070.
5. Turunen M, Olsson J, Dallner G. Metabolism and function of coenzyme Q. Biochim
Biophys Acta. 2004;1660(1-2):171-199.
6. Shields KM. Use of ubiquinone (Coenzyme Q10) in patients taking statins. Pharma-
cist’s Letter/Prescriber’s Letter. 2004; Detail-Document #200420.
7. Gregory PJ. Coenzyme Q10 for statin-induced myopathy. Prescriber’s Letter. 2000;
Detail-Document #161009.
8. Bleske BE, Willis RA, Anthony M, et al. The effect of pravastatin and atorvastatin on
coenzyme Q10. Am Heart J. 2001;142(2):E2.
9. Rumor vs. truth: patients on statins should take coenzyme Q10 to prevent myop-
athies. Prescriber’s Letter. Available at: http://www.prescribersletter.com. Accessed
November 7, 2006
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